March 19, 2013
Individual Approach Works Best When It Comes To Treating Sports-Related Concussions
WATCH VIDEO: [UCLA UNCUT: Concussions, Youth and Recovery]
Michael Harper for redOrbit.com — Your Universe OnlineIn 1997, the American Academy of Neurology (AAN) created a set of guidelines on the best ways to diagnose and treat a concussion. These guidelines suggested a fixed rest time for athletes who took a good knock on the head.
After more than 15 years, the neurology group has updated its guidelines and now suggests doctors and on-the-field trainers take an individual approach when determining how long a player should sit out of the game.
Yet, even with these revised guidelines, the AAN says some of the proposed tests to diagnose a concussion are less than perfect. Doctors and trainers may be encouraged to operate on a case by case basis, but their calls could still be potentially dangerous if they´ve been unable to properly diagnose a concussion.
One aspect of the new guidelines remains unchanged: any athlete suspected of having suffered a concussion should be pulled from the field immediately to avoid the risk of further exacerbating the head trauma. Whereas the previous guidelines suggested a fixed rest time of 10-days, the AAN now says trainers can use their best judgement and send an athlete back to the field at any time. These trainers are urged, of course, to take caution and avoid potential for a repeat concussion.
"We've moved away from the concussion grading system we first established in 1997 and are now recommending [that] concussion and return to play be assessed in each athlete individually," writes Dr. Christopher Giza and colleagues on the revised changes. "There is no set time line for safe return to play."
When a trainer suspects an athlete may have a concussion, they perform a set of “baseline assessments” to determine if the athlete does have a concussion and, if so, how bad it is. High school and college-level trainers are, of late, required to learn these baseline assessments and perform tests anytime they suspect a player may have experienced some head trauma. By using these tests, a trainer should be able to determine when a player can safely return to the field.
Yet, the AAN says a concussion can be a tricky thing to diagnose on the field. Even the best of the newly proposed baseline assessments will only detect 4 out of every 5 concussions. What´s more, the academy found these assessments can lead to a player being unnecessarily removed from the game in one out of every ten cases. The AAN said these tests "may be helpful tools in diagnosing and managing concussions, but should not be used alone for making a diagnosis."
"There is not a diagnostic tool that is supported in the literature that can diagnose an injury, or that can diagnose when an injury is over," said Dr. Jeffrey Kutcher with the University of Michigan.
The inconsistency of these assessments has led the AAN to urge trainers to make their decisions on a case-by-case basis.
The new guidelines also point out some symptoms – such as disorientation, early amnesia, fatigue and headache – could lead to longer recovery times. Furthermore, the new guidelines suggest trainers tell their patients to expect some of the same symptoms in the following days and weeks of recovery.
For instance, a football player who´s just taken a significant hit to the head could continue to have a headache and difficulty concentrating for weeks after the initial injury. Though the new guidelines suggest trainers approach each concussion on a case-by-case basis, they also say some athletes may never be able to walk onto the field again without some risk of “permanent or lasting neurobehavioral or cognitive impairments.”